Fetal surgery isindicated in conditions which interfere with the normal development of the fetus, which when corrected will allow normal development of the fetus. Fetal surgeries can be performed in the form of open, fetoscopic, shunt therapy, radiofrequency ablation, fetal intracardiac catheter procedures and ex-utero-intrapartum-treatment (EXIT) procedures to correct various fetal anatomical defects.Examples of conditions treated by fetal surgeries include twin to twin transfusion syndrome (TTTS), congenital diaphragmatic hernia fetal tracheal occlusion, cystoscopic laser treatment of posterior urethral valves, and laser therapy of vocal cord occlusion in congenital high-airway obstruction sequence, and release of amnionic bands. In utero environment supports rapid post-operative healing, rapid healing, fostered by fetal growth factor, infections are combated by passage of maternal immune factors, umbilical circulation meets nutritional and respiratory needs without outside assistance and medical agents given directly to fetus have greater efficacy at reduced doses are the advantages of fetal surgeries over ex-utero surgical corrections. Over these advantages, there are challenges which have to be faced by the surgeons’ are ethical dilemma, higher maternal and fetal risk, anesthesia risks, need for post-surgical tocolysis, fetal pain etc. It is not possible to assess fetal pain directly, assessed indirectly by ability of fetus to mount a stress response to noxious stimulus-increased fetal cortisol, beta-endorphins and central sparing hemodynamic changes. Fetal stress to pain starts in 8 weeks gestation age and may cause preterm labour. Researches are under the evaluation related to delivering stem cells or DNA to treat sickle cell anemia or other genetic conditions and inherited genetic diseases, prevention of graft v/s host disease and intra-amniotic or intra-umbilical vein.
Review Article
P. 37-41
